Healthcare Provider Details

I. General information

NPI: 1275589145
Provider Name (Legal Business Name): ASHISH K CHAKRAVARTHY MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/25/2006
Last Update Date: 11/06/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1260 UNIVERSITY AVE
SEWANEE TN
37375-2303
US

IV. Provider business mailing address

PO BOX 634706
CINCINNATI OH
45263-0001
US

V. Phone/Fax

Practice location:
  • Phone: 931-598-5691
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207P00000X
TaxonomyEmergency Medicine Physician
License Number030804
License Number StateTN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: